Download - Neuroradiology Case Presentation
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Radiology Case Presentation
David R. Beckert, MS-4
11/8/05
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Case Background
• Clinical History: 22 y.o. female presented to Neuro angio for imaging of AVM, which was discovered at OSH, in order to proceed to interventional radiology for gamma knife ablation procedure.
• (Note: Unclear as to her original complaint that lead to the discovery of the AVM at the OSH)
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Radiographic Images
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Medium-sized AVM
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• Blood flow to AVM from internal carotid and vertebral
• Distal venous stricture also noted
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Arteriovenous malformations
• Intracranial AVMs = 0.1% prevalence (aneurysms =1.0%).
• Supratentorial lesions = 90%
• Posterior fossa = 10%
• AVMs account for:– 1 to 2 % of all strokes– 3 % of strokes in young adults– 9 % of subarachnoid hemorrhages
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AVM Clinical Summary
• AVMs usually present in the second to the fourth decade of life.
• Presentation: – Intracranial hemorrhage = 41-79 %– Seizures = 11-33 %– Headaches or progressive deficit– Younger patients (<30 yo) most often present
with seizures, while older patients more commonly present with hemorrhage
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AVM Imaging
• Angiography is the gold standard for the diagnosis, treatment planning, and follow-up after treatment
• Anatomical and physiological information such as the nidus configuration, its relationship to surrounding vessels, and localization of the draining or efferent portion of the AVM are readily obtained
• Contrast transit times provide additional useful information regarding the flow state of the lesion; this is critical for endovascular treatment planning
• AVMs typically first discovered via MRI/CT• MRI- very sensitive for location purposes and following
pts after treatment
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AVM Grading Scale
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AVM Treatment• Pt. Age is most important factor• Options include surgery, stereotactic radiosurgery, and
endovascular embolization• Stereotactic radiosurgery — Stereotactically focused high energy
beams of photons or protons to a defined volume containing the AVM nidus induces progressive thrombosis.
• Time course usually one to three years, and the time between treatment and obliteration is referred to as the latency period.
• Once the lesion is completely obliterated, the hemorrhage risk from the AVM is very low
• Successful AVM obliteration with radiosurgery depends upon lesion size and dose of radiation (complications also depend on location/size of AVM and volume treated)
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References
• Singer, RJ, Ogilvy, CS, Rordorf, G. Cerebral arteriovenous malformations. UpToDate Online 13.3. February 25, 2005.
• Spetzler, RF, Martin, NA. A proposed grading system for arteriovenous malformations. J Neurosurg 1986; 65:476.